Patients with complex coronary lesions undergoing percutaneous coronary intervention (PCI) have more major adverse cardiac events (MACE) than do those with simpler one. Therefore, intensive antiplatelet therapy might be needed in these patients. A total of 127 patients with complex lesion undergoing PCI in the Second Hospital of Tianjin Medical University from October 2012 to April 2014 were randomized to receive: dual (aspirin plus clopidogrel, DAPT, n=66) or triple antiplatelet therapy (aspirin plus clopidogrel plus cilostazol, TAPT, n=61). Patients in TAPT group received low‐dose cilostazol (100mg loading, followed with 50mg BID) for 3‐6 months. The primary endpoint was composite MACE. The complex coronary target lesions were defined as at least one of the followings: left main disease, severe 3‐vessel disease, chronic total occlusion lesions, true bifurcation lesion, ostial lesions, severe calcified lesions and highly thrombotic lesions. The two groups had similar baseline clinical and angiographic characteristics. One‐year clinical outcomes showed that TAPT group had significantly lower incidences of myocardial infarction (1.6% vs 13.6%, P=0.018) and MACE (1.6% vs 16.7%, P=0.004) than DAPT group. DAPT group had 2 cases of stent thrombosis, while TAPT group didn't. Furthermore, adjunctive low‐dose cilostazol didn't significantly increase the incidence of bleeding events (26.2% vs 19.7%, P=0.381) regardless of major (4.9% vs 4.5%, P=0.921) or minor (21.3% vs 15.2%, P=0.368) bleeding events. In conclusion, low‐dose adjunctive cilostazol seems superior to dual antiplatelet therapy in reducing recurrent ischemic events in patients with complex coronary lesions and two groups have similar incidence of bleeding events. This article is protected by copyright. All rights reserved.